Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Issue title: Gait Disorders in Alzheimer’s Disease and Other Dementias

Guest editors: Manuel Montero-Odasso and George Perry

Article type: Research Article

Authors: Rosso, Andrea L.^{a; *} | Metti, Andrea L.^a | Faulkner, Kimberly^a | Redfern, Mark^b | Yaffe, Kristine^c | Launer, Lenore^d | Elizabeth Shaaban, C.^{a; e} | Nadkarni, Neelesh K.^f | Rosano, Caterina^a

Affiliations: [a] Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA | [b] Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA | [c] Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA, USA | [d] Intramural Research Program, National Institute on Aging, Bethesda, MD, USA | [e] Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA | [f] Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Correspondence: [*] Correspondence to: Andrea Rosso, 5137 Public Health, 130 De Soto Street, Pittsburgh, PA 15261 412-383-1066, USA. E-mail: alr143@pitt.edu.

Abstract: Background:Performance on complex walking tasks may provide a screen for future cognitive decline. Objective:To identify walking tasks that are most strongly associated with subsequent cognitive decline. Methods:Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8-9 years post-walking assessment. Results:Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. Conclusion:Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.

Keywords: Cognitive disorders, epidemiology, geriatrics, walking speed

DOI: 10.3233/JAD-181140

Journal: Journal of Alzheimer's Disease, vol. 71, no. s1, pp. S65-S73, 2019